Provider Demographics
NPI:1104144211
Name:BARKER, JARED DALE (DO)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:DALE
Last Name:BARKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 EXECUTIVE CENTER DR. STE 250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1678
Mailing Address - Country:US
Mailing Address - Phone:512-579-4000
Mailing Address - Fax:512-439-2814
Practice Address - Street 1:3445 EXECUTIVE CENTER DR.
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1678
Practice Address - Country:US
Practice Address - Phone:512-579-4000
Practice Address - Fax:512-439-2814
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000442207ZP0102X
ARE8492207ZP0102X
TXBP10037259207ZP0102X
TXQ4718207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2396731Medicaid
LA13581400OtherCAQH PROVIDER ID
LA420242YJYPMedicare PIN